Organization
NICO ROUSE CORPORATION P S
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CRAIG ROUSE (PRESIDENT)
(360) 790-1669
Entity
Organization
Contact information
Practice address
8160 FREEDOM LN NE, SUITE D, LACEY, WA 98516-4753
(360) 790-1669
Mailing address
9321 MILBURN LOOP SE, LACEY, WA 98513-3420
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00003743
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3183314
AETNA HMO
—
01
—
4536RO
REGENCE BLUE SHIELD
—
01
—
7283193
AETNA PPO
—
01
—
P00327511 DE9528
RAILROAD MEDICARE PART B
WA
Enumeration date
05/02/2008
Last updated
09/11/2025
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